AccountId: 011433970860
ContactId: c7fca860-bb56-49ea-90a9-b61ac3a615ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 491760 ms
Total Talk Time (AGENT): 159365 ms
Total Talk Time (CUSTOMER): 224855 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/c7fca860-bb56-49ea-90a9-b61ac3a615ea_20250117T15:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, with, uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, we want to ask you a question about being turned down for radiation and stuff, but I need you to talk to my wife, [PII]. You have permission to talk to her so she can explain everything. Maybe we can figure out what's going on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, yes, [PII]. Can you give me your policy number, sir?
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] I'll need to verify just a little information with you, please, Mr. [PII] before I can speak to Miss [PII], um.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5381 OK 5,381,110.
[AGENT][NEUTRAL] I'll just need
[AGENT][NEUTRAL] 538,110.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me pull in that policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Mr. [PII], can you
[CUSTOMER][NEUTRAL] My policy is.
[AGENT][NEUTRAL] Can you give me your date of birth, please, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then I'll also need for you to verify your address, phone number, and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] OK, my wife is the one that's got the email, so she'll have to do that, but my address is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]. The email is [PII]. And and uh her email is [PII].
[AGENT][POSITIVE] Thank you so much, Mr. [PII]. I appreciate you verifying your policy for me. I can speak to Ms. [PII] now if that's OK with you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] All right, thank you. Hi, Miss [PII], this is [PII].
[CUSTOMER][POSITIVE] Hi, thank you.
[CUSTOMER][NEUTRAL] OK, we submitted a claim in uh November, uh, I forget, uh, anyway, I submitted it for, he had 10 radiation treatments and uh it didn't pay, it doesn't look like it paid anything on the radiation treatments.
[CUSTOMER][NEUTRAL] Uh, we, we did get a payment. He had a Tegriso prescription and it, it did pay for that and it paid for the $75 called Wellness, but it didn't pay anything for the.
[CUSTOMER][NEUTRAL] Radiation treatment.
[AGENT][NEUTRAL] OK, so looking at um the claim.
[AGENT][NEGATIVE] Uh, the reason why it didn't pay.
[AGENT][NEUTRAL] I do see that it didn't pay the mileage because it has to be 50 miles from your legal residence, but the.
[CUSTOMER][NEUTRAL] Right, but see, we wasn't, we wasn't, I didn't file anything for mileage. I didn't need.
[AGENT][NEUTRAL] OK, and then on the rest of what was not paid, the calendar year maximum for the benefit had been exhausted with the payment of the claim.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Even though he had those 10 radiation treatments there, that there is, it won't pay anything for those because the maximum has been met.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, what is the what is the maximum?
[CUSTOMER][NEUTRAL] I didn't read any policy that there was a yearly maximum, but can you give that?
[CUSTOMER][NEUTRAL] Can you give that to us? radiation.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes ma'am, let me look.
[AGENT][NEUTRAL] OK. Let me look and see on your policy.
[AGENT][NEUTRAL] Yep, so that we can read it and see.
[CUSTOMER][NEUTRAL] OK, and I, I have another question when you're finished looking.
[AGENT][NEUTRAL] The chemo maximum was $500.
[CUSTOMER][NEUTRAL] The what maximum?
[AGENT][NEUTRAL] The chemo maximum benefit amount and this is just to verify your benefits it's not a guarantee of payment. So on your chemo you have $500. Your first occurrence benefit is $5000.
[AGENT][NEUTRAL] And your daily hospital is 100.
[CUSTOMER][POSITIVE] Yeah, I do.
[CUSTOMER][NEGATIVE] OK, I'm losing you. I don't know why.
[AGENT][NEUTRAL] Your radiation and chemotherapy benefit.
[AGENT][NEUTRAL] Is $500.
[CUSTOMER][NEUTRAL] OK, but see, we've not ever found anything for radiation.
[CUSTOMER][NEUTRAL] I see.
[AGENT][POSITIVE] Well, it's together radiation and chemotherapy, the benefit is together and it's $500.
[CUSTOMER][POSITIVE] Yes she feels honey, we have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, that, that still doesn't, it doesn't.
[CUSTOMER][NEGATIVE] It just doesn't make any sense, but I mean, I, we, I guess we have to go by what you guys pay. Uh.
[CUSTOMER][NEUTRAL] But it says for the calendar year, I mean, is there a total monetary amount for the whole year that there's a limit on?
[CUSTOMER][NEUTRAL] No matter what he had treatment he has to have?
[AGENT][NEUTRAL] Yes, ma'am. And then that's the $500.
[AGENT][NEUTRAL] And then the uh the first occurrence benefit, the first diagnosis of cancer benefit pays $5000.
[CUSTOMER][NEUTRAL] OK, OK, so we just submitted another claim for the IV chemotherapy he had to have in.
[CUSTOMER][NEUTRAL] Uh, November and December, so will the claim pay anything on that?
[AGENT][NEUTRAL] Uh, I am not sure about that. It has to go through the claims adjusters, um, the examiners. I do see that we received it on [PII], and it's in progress.
[CUSTOMER][POSITIVE] Yes ma'am, yes.
[CUSTOMER][NEUTRAL] Right, right, OK.
[CUSTOMER][POSITIVE] All right. Well, thank you so much. You have a good day.
[AGENT][POSITIVE] You're very welcome. You too. You guys have a blessed one and thank you for calling APL, Miss [PII] and tell Mr. [PII] I said thank you also.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] OK, bye bye.